Provider Demographics
NPI:1881645950
Name:SCHELL, PEGGY JO (DO)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:JO
Last Name:SCHELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MARKET ST
Mailing Address - Street 2:SUITE 35
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-2600
Mailing Address - Country:US
Mailing Address - Phone:570-389-1607
Mailing Address - Fax:
Practice Address - Street 1:1000 MARKET ST
Practice Address - Street 2:SUITE 35
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-2600
Practice Address - Country:US
Practice Address - Phone:570-389-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007074E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E46124Medicare UPIN
PASC613668Medicare ID - Type Unspecified